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 Researchers interviewed families and caregivers of 730 terminally
ill patients about their experiences with the 3 Wishes Project
(3WP), a program designed to create meaningful patient- and
family-centered memories as part of compassionate end-of-life care.
"3WP facilitates compassionate care by recognizing the inherent
dignity of dying patients and encouraging connections among
patients, clinicians, and family members," Dr. Deborah Cook of
McMaster University in Hamilton, Ontario, and colleagues write in
the Annals of Internal Medicine.
The goal of the study was to see how feasible it might be to
implement the 3WP program at multiple facilities, how much families
and clinicians appreciated the experiences, and how much it might
cost to grant wishes to dying patients and their families on a
regular basis.
The program focused on dying patients in intensive care units at
four hospitals. Most required mechanical ventilation to breathe as
well as medication to help their heart pump blood. Many were also on
dialysis because their kidneys were failing.
Wishes varied widely and included things like taking patients
outdoors, putting up seasonal decorations in hospital rooms,
celebrating occasions like birthdays or anniversaries, renewing
wedding vows, allowing for unlimited visitors, or assisting with
legacies like organ donation or blood drives.
Overall, 3,325 wishes were granted. On averages, wishes cost only
$5.19 apiece. Granting wishes appeared sustainable, given that
hospitals continued to offer the 3WP program even after the study
year ended.
Family members and clinicians interviewed about 3WP felt the wishes
helped foster human connection and helped family, friends, and
caregivers focus on patients' identities as unique individuals.
This runs counter to sterile intensive care environment where
illness severity, reliance on technology, and patients' inability to
communicate can make it hard to deliver optimal end-of-life care,
the study team writes.
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Family members were comforted by having the opportunity to connect
with each other and forge meaningful relationships with clinicians,
appreciating clinicians' explicit recognition of the dignity of
their loved ones, researchers note.
Memory-making activities embedded in 3WP catalyze respectful care
that may encourage families to recall positive memories of their
loved one as a person, not a patient, which may ease grief,
researchers also point out.
Focusing on connection and legacy may help ease some of the grief,
stress, depression, and anxiety experienced by people whose family
members die in the ICU, researchers note.
Humanizing the ICU experience for dying patients may also help
address the needs of staff members who have high levels of burnout
and distress, the study team writes. Clinicians' negative
experiences and feelings can be exacerbated when dying patients
receive care that's inconsistent with their wishes or prognosis or
when communication with families doesn't clarify what might help
make the best of a bad situation. With 3WP, clinicians and families
have a framework to collaborate in honoring patients during their
final days, which may help improve job satisfaction for clinicians.
One limitation of the study is that most patients were incapacitated
and unable to respond to wishes or participate in interviews about
the experiences, the study team notes. This means the program was
evaluated based on its impact only on families and caregivers.
SOURCE: https://bit.ly/2rA3QHF Annals of Internal Medicine, online
November 11, 2019.
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